Human Papillomavirus

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.
Some of these viruses are called “high-risk” types, and may cause abnormal Pap tests. They may lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called “low-risk” types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower shaped. By age 50, at least 80 percent of women will have acquired genital HPV infection.

Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50 percent of sexually active men and women get it at some point in their lives.

About 1 percent of sexually active adults in the United States have genital warts at any one time.

Each year, about 12,000 women get cervical cancer in the United States almost all of these cancers are HPV-associated

These are less common than cervical cancer. Each year in the United States, there are about:

• 1,500 women who get HPV-associated vulvar cancer
• 500 women who get HPV-associated vaginal cancer
• 400 men who get HPV-associated penile cancer
• 2,700 women and 1,500 men who get HPV-associated anal cancer
• 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may be related to tobacco and alcohol use.]

Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners even when the infected partner has no signs or symptoms.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP).

Usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.

Usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer . Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

Might not have signs or symptoms until they are advanced and hard to treat. These include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils). For signs and symptoms of these cancers, see www.cancer.gov.

HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.

Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women older than 30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary.

The HPV tests on the market are only used to help screen women at certain ages and with certain Pap test findings, for cervical cancer. There is no general test for men or women to check one’s overall "HPV status," nor is there an approved HPV test to find HPV on the genitals or in the mouth or throat.

There is no “cure” for HPV infection, although in most women the infection goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix.

Visible genital warts can be removed by the patient with prescribed medications. The warts can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.

Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment.

The HPV vaccine is safe and effective in preventing the common infection and is recommended for teenagers and adults who were not vaccinated as children.

All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types can lead, in rare cases, to development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer.

A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. For 2004, the American Cancer Society estimates that about 10,520 women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.

• HPV Brochure
• US Centers for Disease Control and Prevention
• American Sexual Health Association